|
HC MOHC LNAR DISK
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.97
|
| Rate for Payer: Blue Shield of California Commercial |
$20.77
|
| Rate for Payer: Blue Shield of California EPN |
$13.57
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: InnovAge PACE Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Riverside University Health System MISP |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC MOHC LNAR DISK
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
909001084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.03
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.02
|
| Rate for Payer: InnovAge PACE Commercial |
$487.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Riverside University Health System MISP |
$389.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
905352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$399.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$535.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$730.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.03
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$827.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$827.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$827.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$444.02
|
| Rate for Payer: InnovAge PACE Commercial |
$487.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$681.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$681.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$487.00
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: Riverside University Health System MISP |
$389.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$584.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$584.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$827.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$827.90
|
| Rate for Payer: Vantage Medical Group Senior |
$827.90
|
|
|
HC MOLDED INNER BOOT ADDITION LE
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT L2280
|
| Hospital Charge Code |
915352280
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Adventist Health Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California Commercial |
$752.90
|
| Rate for Payer: Blue Shield of California EPN |
$490.90
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Central Health Plan Commercial |
$779.20
|
| Rate for Payer: Cigna of CA HMO |
$681.80
|
| Rate for Payer: Cigna of CA PPO |
$681.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: EPIC Health Plan Senior |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$876.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$602.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.80
|
| Rate for Payer: Multiplan Commercial |
$730.50
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$365.54
|
| Rate for Payer: United Healthcare All Other HMO |
$355.80
|
| Rate for Payer: United Healthcare HMO Rider |
$348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.99
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.41 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.68
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$355.23
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
905352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.41 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$346.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$464.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$495.68
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$717.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$717.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$717.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$355.23
|
| Rate for Payer: InnovAge PACE Commercial |
$422.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$590.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$590.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$422.00
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: Riverside University Health System MISP |
$337.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$506.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$506.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$717.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$717.40
|
| Rate for Payer: Vantage Medical Group Senior |
$717.40
|
|
|
HC MOLDED LACER KAFO ADDITION LE
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT L2330
|
| Hospital Charge Code |
915352330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$759.60 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Blue Shield of California Commercial |
$652.41
|
| Rate for Payer: Blue Shield of California EPN |
$425.38
|
| Rate for Payer: Cash Price |
$464.20
|
| Rate for Payer: Central Health Plan Commercial |
$675.20
|
| Rate for Payer: Cigna of CA HMO |
$590.80
|
| Rate for Payer: Cigna of CA PPO |
$590.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.60
|
| Rate for Payer: EPIC Health Plan Senior |
$337.60
|
| Rate for Payer: Galaxy Health WC |
$717.40
|
| Rate for Payer: Global Benefits Group Commercial |
$506.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$759.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$562.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$522.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.80
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: Networks By Design Commercial |
$548.60
|
| Rate for Payer: Prime Health Services Commercial |
$717.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.75
|
| Rate for Payer: United Healthcare All Other HMO |
$308.31
|
| Rate for Payer: United Healthcare HMO Rider |
$301.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.41
|
|
|
HC MOLDED SHLDR ARM FOREARM &WRST
|
Facility
|
OP
|
$1,860.00
|
|
| Hospital Charge Code |
903203963
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.15 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,581.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,023.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,395.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,092.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,437.78
|
| Rate for Payer: Blue Shield of California EPN |
$937.44
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,488.00
|
| Rate for Payer: Cigna of CA HMO |
$1,302.00
|
| Rate for Payer: Cigna of CA PPO |
$1,302.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,581.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,581.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,581.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.00
|
| Rate for Payer: EPIC Health Plan Senior |
$744.00
|
| Rate for Payer: Galaxy Health WC |
$1,581.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,116.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,674.00
|
| Rate for Payer: InnovAge PACE Commercial |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,240.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,151.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$762.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,302.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,302.00
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: Networks By Design Commercial |
$930.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,581.00
|
| Rate for Payer: Riverside University Health System MISP |
$744.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,116.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,116.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.06
|
| Rate for Payer: United Healthcare All Other HMO |
$679.46
|
| Rate for Payer: United Healthcare HMO Rider |
$664.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$609.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,581.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,581.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,581.00
|
|
|
HC MOLDED SHLDR ARM FOREARM &WRST
|
Facility
|
IP
|
$1,860.00
|
|
| Hospital Charge Code |
903203963
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,674.00 |
| Rate for Payer: Adventist Health Commercial |
$372.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,437.78
|
| Rate for Payer: Blue Shield of California EPN |
$937.44
|
| Rate for Payer: Cash Price |
$1,023.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,488.00
|
| Rate for Payer: Cigna of CA HMO |
$1,302.00
|
| Rate for Payer: Cigna of CA PPO |
$1,302.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.00
|
| Rate for Payer: EPIC Health Plan Senior |
$744.00
|
| Rate for Payer: Galaxy Health WC |
$1,581.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,116.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,674.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,240.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,151.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,395.00
|
| Rate for Payer: Networks By Design Commercial |
$1,209.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,581.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.06
|
| Rate for Payer: United Healthcare All Other HMO |
$679.46
|
| Rate for Payer: United Healthcare HMO Rider |
$664.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$609.15
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
IP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$346.96 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Central Health Plan Commercial |
$308.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.20
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.10
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
|
|
HC MOLECULAR CYTOGEN DNA PROBE,EA
|
Facility
|
OP
|
$385.51
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
903800160
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,234.22 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.49
|
| Rate for Payer: Blue Shield of California Commercial |
$234.00
|
| Rate for Payer: Blue Shield of California EPN |
$153.05
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Cash Price |
$212.03
|
| Rate for Payer: Central Health Plan Commercial |
$308.41
|
| Rate for Payer: Cigna of CA HMO |
$246.73
|
| Rate for Payer: Cigna of CA PPO |
$285.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: InnovAge PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$257.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$289.13
|
| Rate for Payer: Networks By Design Commercial |
$250.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$343.80 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.75
|
| Rate for Payer: Blue Shield of California Commercial |
$231.87
|
| Rate for Payer: Blue Shield of California EPN |
$151.65
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Central Health Plan Commercial |
$305.60
|
| Rate for Payer: Cigna of CA HMO |
$244.48
|
| Rate for Payer: Cigna of CA PPO |
$282.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$324.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.38
|
| Rate for Payer: InnovAge PACE Commercial |
$191.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$267.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$267.40
|
| Rate for Payer: Multiplan Commercial |
$286.50
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
| Rate for Payer: Riverside University Health System MISP |
$152.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2.52
|
| Rate for Payer: United Healthcare HMO Rider |
$2.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$324.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.70
|
| Rate for Payer: Vantage Medical Group Senior |
$324.70
|
|
|
HC MOLECULAR PATH INTERPRETATION
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT G0452
|
| Hospital Charge Code |
903800940
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$343.80 |
| Rate for Payer: Adventist Health Commercial |
$76.40
|
| Rate for Payer: Cash Price |
$210.10
|
| Rate for Payer: Central Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$152.80
|
| Rate for Payer: Galaxy Health WC |
$324.70
|
| Rate for Payer: Global Benefits Group Commercial |
$229.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$343.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$254.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$236.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.40
|
| Rate for Payer: Multiplan Commercial |
$286.50
|
| Rate for Payer: Networks By Design Commercial |
$248.30
|
| Rate for Payer: Prime Health Services Commercial |
$324.70
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$658.00
|
| Rate for Payer: United Healthcare All Other HMO |
$658.00
|
| Rate for Payer: United Healthcare HMO Rider |
$658.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$658.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$539.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$772.89
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC MONITRNG FLUID PRESSURE/MUSCLE
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
900501343
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
|
|
HC MONOSPOT (INFECT. MONO TEST)
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
900910867
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$32.78
|
| Rate for Payer: Blue Shield of California EPN |
$21.44
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$374.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.62
|
| Rate for Payer: Blue Shield of California Commercial |
$171.17
|
| Rate for Payer: Blue Shield of California EPN |
$111.95
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$121.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC MOTOR NCS W/F-WAVES
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95905
|
| Hospital Charge Code |
900600257
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC MOTOR & SENS 11-12 NRV CNDJ TEST
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 95912
|
| Hospital Charge Code |
900600329
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$294.80 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Adventist Health Commercial |
$294.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$895.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$654.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$865.68
|
| Rate for Payer: Blue Shield of California Commercial |
$894.72
|
| Rate for Payer: Blue Shield of California EPN |
$585.18
|
| Rate for Payer: Cash Price |
$810.70
|
| Rate for Payer: Cash Price |
$810.70
|
| Rate for Payer: Cash Price |
$810.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,179.20
|
| Rate for Payer: Cigna of CA HMO |
$943.36
|
| Rate for Payer: Cigna of CA PPO |
$1,090.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,252.90
|
| Rate for Payer: Global Benefits Group Commercial |
$884.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,326.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$983.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,105.50
|
| Rate for Payer: Networks By Design Commercial |
$958.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,252.90
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$884.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$884.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
